Original Contribution
No Racial Disparities in the Treatment of ST Elevation Myocardial Infarction – A Community-based Experience Abhijeet Basoor, Gagan Randhawa, John F Cotant, Nishit Choksi, Abdul R Halabi, Kiritkumar C Patel and Michele DeGregorio Division of Cardiology, Department of Internal Medicine, St. Joseph Mercy Oakland Hospital, Pontiac, Michigan, US
Abstract Whether racial disparities exist in the treatment of ST elevation myocardial infarction (STEMI) is not exactly known. We report a retrospective chart review of patients with first event of STEMI, in two groups separated by one decade. Results revealed that hospital mortality in the 2007 and 1997 groups for African Americans versus Caucasians was one of 22 versus 21 of 170, 95 % confidence interval (CI) -0.178 to 0.022, p=0.48 and four of 41 versus 39 of 402, 95 % CI -0.095 to 0.096, p=1.00, respectively. The mean length of stay (LOS) for African Americans and Caucasians in the 2007 and 1997 groups was 5.7 versus 4.1 days (p=0.09) and 7.3 versus 6.6 days (p=0.42), respectively. During follow-up, a total of 40 patients needed re-intervention in the 2007 group. The re-intervention rate in African American patients being 13.6 % (three of 22) versus 21.2 % (36 of 170) in Caucasians, 95 % CI -0.231 to 0.081, with p=0.57. In conclusion, there was no evidence of racial disparity in the treatment of STEMI in terms of hospital mortality, length of hospital stay and re-intervention rate.
Keywords ST elevation myocardial infarction, racial disparities, African Americans, Caucasians Disclosure: The authors have no conflicts of interest to declare. Received: 20 April 2013 Accepted: 30 July 2013 Citation: Interventional Cardiology Review, 2013;8(2):140–2 Correspondence: Abhijeet Basoor, Division of Cardiology, Medical Education – Fourth Floor, St. Joseph Mercy Oakland, 44405 Woodward Avenue, Pontiac, Michigan 48341, Michigan, US. E: drasbasoor@hotmail.com
In the US, over the past 30 years, advances in cardiovascular care have resulted in a dramatic decline in mortality and morbidity associated with ST elevation myocardial infarction (STEMI) and non-STEMI.1,2 The overall incidence of coronary heart disease (CHD) has decreased over the last four decades.3 There are various reports about disparities in healthcare and the higher mortality among African Americans in CHD.3–5 There are few reports looking at racial disparities in the treatment of STEMI. We present our community-based experience demonstrating the disparities among African Americans and Caucasians in the treatment of STEMI.
Hypothesis The study was designed to test the hypothesis that there is a disparity in the treatment of STEMI among African Americans and Caucasians.
Methods and Design A retrospective chart review on two STEMI population groups was performed – October 1995 to July 1997 (first) and October 2005 to July 2007 (second). Each of the two groups comprised patients with first event of STEMI in an 18-month timeframe at our community teaching hospital, St. Joseph Mercy Oakland, Pontiac, Michigan, US. The institutional Review Board approved this retrospective review protocol. Data collection included patient demographics, insurance status, co-morbidities, hospital length of stay (LOS) and their clinical outcome with complications if any. Based on the risk for CHD at different age for men and women, and recommendations for treatment for dyslipidaemia from the Adult
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Treatment Panel (ATP) III report,6 young population in our study was defined as: males <45 years of age and females <55 years of age. In the second group, population was characterised as obese if their body mass index (BMI) was greater than or equal to 30 kilograms/ square metres (kg/m2). Tobacco use was defined as any patient who had secondary diagnoses of history of tobacco use and/or tobacco use disorder. Racial disparities between African Americans and Caucasians were measured using their hospital mortality and LOS in the two population groups and re-intervention rate in the second group. Mortality was defined as any STEMI patient who was brought to the hospital and who died during the hospital stay either with or without invasive treatment. In the second group, re-intervention rate was calculated by review of follow-up heart catheterisation reports, if performed. In this group, all patient charts were retrieved for a minimum follow-up period of one year (until July 2008) in order to determine rate of re-intervention procedures. The other details relevant to the methods and statistical tests used can be found in our previously published report from this investigation.7
Results Patient Characteristics In the first group 1995–1997 (1997 group) a total of 455 subjects were included, with males comprising 64 % of the group (289 of 455). In the second group 2005–2007 (2007 group) there was a total of 206 patients, with males comprising 65 % of the group (134 of 206). The basic characteristics of the two groups are shown
© RADCLIFFE 2013
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